Struggling with Persistent Acne: Causes and Solutions for Clear Skin

The issue of acne has been troubling me for a long time?

Hello Doctor: Since I developed a large pimple on my nose in sixth grade, acne has been a persistent issue for me, and now I'm almost twenty.
Initially, the acne kept recurring on my nose, but now it has shifted to my chin and the sides of my cheeks near my nose and mouth (I never had acne on my chin before, but now it is not only severe but also very red and swollen with little bumps).
Sometimes, I can smell a pus-like odor.
When I see doctors, they say it’s due to elevated male hormones, and the medications prescribed have had inconsistent results.
I’m wondering if there are any methods to suppress the acne? Additionally, sometimes I notice a pus-like smell, and when I press a specific spot on my nose, pus comes out.
What could this issue be?

Yao, 10~19 year old female. Ask Date: 2012/04/25

Dr. Yang Zhiya reply Dermatology

There are many causes of acne, including oily skin, inadequate cleansing, environmental pollution, lifestyle habits, diet, and hormones.
Your situation sounds more like pustular acne.
It is recommended that you work closely with your dermatologist for treatment to minimize the risk of scarring in the future.

Reply Date: 2012/04/25

More Info

Dealing with persistent acne can be incredibly frustrating, especially when it seems to evolve and spread to different areas of the face over time. Based on your description, it appears that you have been experiencing a significant amount of acne, particularly around the nose, chin, and cheeks, which can be exacerbated by hormonal fluctuations. Let's break down the potential causes and solutions for your situation.

Causes of Persistent Acne
1. Hormonal Fluctuations: As you mentioned, your doctors have indicated that elevated male hormones (androgens) may be contributing to your acne. Hormones can stimulate sebaceous (oil) glands, leading to increased oil production and clogged pores, which can result in acne. This is particularly common during puberty, menstrual cycles, or conditions like polycystic ovary syndrome (PCOS).

2. Bacterial Growth: The presence of pus and a foul odor suggests that there may be an infection or an overgrowth of bacteria, particularly *Propionibacterium acnes*, which thrives in clogged pores. This can lead to inflammatory acne, characterized by red, swollen lesions.

3. Skin Care Products: Sometimes, the products we use can contribute to acne. Heavy creams or comedogenic (pore-clogging) products can worsen the situation. It's essential to use non-comedogenic products, especially if you have oily or acne-prone skin.

4. Diet and Lifestyle: Certain dietary factors, such as high glycemic index foods, dairy, and sugar, can exacerbate acne in some individuals. Stress and lack of sleep can also play a significant role in hormonal balance and skin health.

Solutions for Clear Skin
1. Topical Treatments: Over-the-counter products containing benzoyl peroxide, salicylic acid, or retinoids (like tretinoin) can be effective in treating acne. These ingredients help to reduce inflammation, unclog pores, and promote skin cell turnover. Since you mentioned using tretinoin, ensure you are applying it correctly and consistently, as it can take several weeks to see results.

2. Oral Medications: If topical treatments are insufficient, your doctor may prescribe oral medications. Antibiotics like doxycycline can help reduce inflammation and bacterial growth. Hormonal treatments, such as birth control pills or anti-androgens like spironolactone, may also be effective in managing hormonal acne.

3. Professional Treatments: Procedures such as chemical peels, laser therapy, or extraction by a dermatologist can help manage persistent acne. These treatments can reduce inflammation, improve skin texture, and minimize scarring.

4. Skincare Routine: Establishing a gentle skincare routine is crucial. Use a mild cleanser, avoid harsh scrubs, and incorporate a good moisturizer suitable for acne-prone skin. Regular exfoliation can help prevent clogged pores, but be cautious not to over-exfoliate, as this can irritate the skin.

5. Dietary Adjustments: Consider keeping a food diary to identify any potential triggers. Reducing sugar and dairy intake may help some individuals. Incorporating anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, can also support skin health.

6. Consult a Dermatologist: Since your acne has persisted and evolved, it is essential to work closely with a dermatologist. They can provide tailored advice and treatment options based on your specific condition and skin type.

Conclusion
Persistent acne can be a complex issue influenced by various factors, including hormones, bacteria, and lifestyle choices. By understanding the underlying causes and implementing a comprehensive treatment plan, you can work towards clearer skin. Remember, patience is key, as effective acne treatment often takes time to show results. If you notice any worsening of symptoms or new concerns, don’t hesitate to reach out to your healthcare provider for further evaluation and support.

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